How Much Should I Trust My Dermatologist?

How much should I trust my dermatologist!?

I am a 24 year old male and over the past year I have noticed some subtle signs of hair loss (my hair began to feel slightly thinner when I ran my hands through it, initially just in the front, but then around the back/crown as well… although i’ve noticed that it still feels thicker around the sides and the nape of my neck). Additionally I noticed some very slight recession on the right side of my front hairline.

All these changes were only noticeable to me, and I have asked many friends and family to examine my hair closely and they all think I am paranoid and have a thick head of hair. However, I finally went to the dermatologist two weeks ago and he looked at my head for about 30 seconds with a magnifying glass and said that he did see some slight thinning at either side of the periphery of the crown (so not in the center of the crown area). Interestingly, this is not where I “felt” my hair thinning. He prescribed propecia, and I have started taking it. However, I asked him several questions about what extent of hair loss I should expect should I choose not to take the drug and all I got from him was that I could expect “further thinning” over the “next 20 years”… he did not mention miniaturization mapping as an option and when I asked about heredity he said that it wouldn’t really tell me all that much to look at other males in my family. Anyway, I was wondering if there was any way I could clarify this further… how much hair loss should I expect given the subtle thinning at my age and my family history??

There is little balding in my family as both of my grandfathers died with full heads of hair… my mom has five brothers, only one of whom has any significant hair loss and he is over 60 and the hair loss occurred later in life; my father’s hair has receded a bit and thinned over time, but he is now in his mid 50s and I would say he is a class II/III with some slight thinning on top and (very slight) around the crown, but still with a good head of hair and no one would consider him bald… in addition, he has a brother is in his 60s and has a full head of hair.

Anyway, I was just wondering if from this information there was any way to make a guess at my future hair loss pattern/rate? I will continue to take the propecia, but is it worth getting a second opinion?

Sadly, not many physicians seem to know of miniaturization studies, as I often write about here. Or if they do know of them, they don’t provide it as a service to their patients. One of the reasons I created a guide to mapping your own scalp is so that you will be empowered to evaluate your own miniaturization. And while a doctor may not call it a “miniaturization study”, if they look at your hair under a microscope it is essentially what they are doing. The key is to have this study done annually (or every 6 months or so) and compare the results so you can see where your hair loss is going or if any treatments are working.

You were obviously concerned enough to seek the advice of your family member and a doctor. If both you and your doctor believe there is some early thinning (miniaturization), Propecia may be a good starting point. I can’t tell you who to trust and not to trust. You need to make that decision on your own and if you still cannot decide (maybe from your paranoia), seek a second opinion from another doctor who may give you a better and more believable opinion.